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ATI MEDSURG UPDATED 2024

ATI MEDSURG UPDATED 2024

ATI MEDSURG UPDATED 2024
hypokalemia ECG reading low potassium = Flat T waves
hypercalcemia deep tendon reflexes too much calcium = Decreased deep tendon
reflexes
hyperkalemia too much potassium = tall peaked T waves
Hypocalcemia low calcium = tetany
addisons disease decreased aldosterone & renin
cushings disease elevated cortisol
hypothyroidism decreased T3 & T4
Diabetes insipidus decreased urine specific gravity
Syndrome of inapproprate secreation of antidiuretic hormone increased
urine osmolarity
diabetes mellitus elevated HbA1c - glycosyated hemoglobin
cataracts progressive , painless loss of vission
Retina detachment sudden loss of vision
open angle glaucoma loss of peripheral
Stable angina occurs with exercise, stress but relieved by nitro
variant angina due to coronary artery spasm, during periods of rest
Unstable angina occurs with exercise, stress but increases in severity over time
maclar degeneration central loss of vision
angle closure glaucoma increased IOP
appendicitis assessment pain at mcburneys point - diagonal from appendices to navel
PUD assessment upper eppigastric pain 1-2 hours after eating.
Cholecystitis assessment pain at murphy sign = upper right under rib .
Pancreatitis assessment turners sign = bruising
decorticate rigidity upper extremities flexed , lower rigid
decerebrate upper extermeties extended away from cerebrum
Hep A transmission ingestion of contaminated food / water - MEXICO
Hep B transmission Sex
Nonviral Hep Drug toxicity
CHF S&S sob, fatigue, DVT, S3
hypovolemic shock position supine with legs elevated
continuous bubbling in chest tube water seal chamber indicated there is a
leak. find leak, tighten the connections or replace drainage system
Stage 3 HIV symptomes -Disseminated or extrapulomonary histoplasmosis .
-kaposi sarcoma.
-burkitts lymphoma .
cardiac injury labs Myoglobin - 24hr marker. troponin - 7day window.
PH 7.45 - 7.35
PCO2 35 - 45
HCo3 22 - 28
Pericarditis abnormal finding Report paradoxical pulse
Seizure Seizure are abrupt excessive and uncontrolled electrical discharge of neurons
within the brain that can cause LOC, or changes in motor / sensory ability and behavior.
Dx: EEG for region
Interventions = move client to floor, patent airway, suction, turn to side, loosen clothing,
document, check vitals, neuro check, reorient.
Treatment = AEDs like phenytoin(lessen effects of warfarin & contraceptives)
Problems = status epilepticus lasting 30+ mins. Airway, oxygen, IV, ECG, O2 sat, ABG, give
loading dose diazepam & IV phenytoin.
Parkinsons Parkinsons is a progressive desease affecting motor function due to over
stimulation of basal ganglia by acetocoline.
Dx: s&S
Interventions : meds, monitor swallowing and nutrition, mobility, communication, mental
and cog status.
Treatment: Increase dopamine or decrease acetocoline. take several weeks. Dopamine
agonists - monitor orthostatic hypotension, dyskenesias, hallucinations.
Anticcholinergics - monitor dry mouth, constipation, ur.
Alzheimers nonreversable dementia charactorized by memory loss, judgment problems,
and changes in personality.
Dx: apolipoprotien
Interventions : asses S&S, sleep/bowel/bladder program, family support group, snacks &
fingerfoods, verbal/nonverbal communication options, memory training, avoid overstim,
promote consistancy and reorient, speak direct in short concise sentences.
Treatment: prevent acetylcholine breakdown (ACH) with donepezil, estrogen, ginko.
Multpiple sclerosis MS is an autommune disorder charactoerized by plaque in the
white matter of CNS. alyloid plaque damages myelin sheath and interferes with impuse
transmission.
Dx: MRI shows plaque, CSF shows elevated protien & WBC.
Intervnetions: monitor swallowing, vision, activity, skin, speech, coping, encourage fluid to
prevent UTIs, bladder/bowel program, communication board, eye patch for diplopia,
exercise, grouping ADLS.
Treatment: Immunosuppressants & antispasmodics.
prednisone= monitor infection, DM, hypok, gi bleeding.
Dantrolene= antispasmotic liver and muscle weakness.
anticholinergics = bladder dys.
ICP interventions ICP intervnetions:
elevate head of bed 30 degrees. maintain patent airway. O2 sat 92% and higher.
keep PaCO@ 35-38 mm Hg.maintain cervical spine stability until cleared by xray.
seizure precautions. manitol and monitor osmolality q6 hrs.
Stroke CVA involve disruption in cerebral blood flow due to ischemia, hemorrahge or
embolism.
Dx: MRI, CT, CAT scans.
Interventions: vitals q1-2hrs report b/p over 180.
monitor temp, maintain co2 92% +, cardiac monitor, LOC, ICP, elevate head of bed 30
degrees, seizure precautions, assist with ADLS, feeding, mobility.
TX: low dose aspirin 24-48hrs after stroke, retavase within 4.5 hrs.
Pulmonary Embolism PE occurs when a substance enters venous circulation and forms
a blockage in the lungs.
dx: elevated D-dimer. tachycardia/pnea, hypotension, extra heart sounds mumor.
Interventions: Watch for hemorrhage and hypotension.
oxy, high fowlers 90%, IV, meds, LOC.
Tx: enoxaprin, heparin, warfarin, activase & streptase.
MI & Angina imbalance btween mycardial oxgen supply and demand. MI is pain lasting
over 30mins only relieved by opioids, Angina is pain lasting less than 15 mins relieved by
nitro.
Dx: myoglobin - marker 24hrs , CK 3days , troponin I 7 days , troponin T 14-21days.
Interventions:
vitals Q15mins until stable, then every hour.
ECG and continuous monitoring.
Output > 30ml/hr.
admin oxygen 2-4 L/min.
IV site.
Heart Failure Heart Failure is when the heart muscle is unable to pump effectivlely
resulting in inadequate cardiac output , hypertrophy, and congestion.
MADD DOG.
Dx: hBNP over 100 = heart failure .
Interventions:
daily weight , I&O.
assess sob, dyspnea & admin oxy.
monitor vitals.
high fowlers 90%.
monitor agb, electrolytes(hypokalemia), o2.
restrict h20 & sodium.
Tx: Diuretics -watch for low potassium.
ACE - watch for hypotension, dry cough normal, b/p 2hrs after dose.
digoxin - toxicity, <60bpm.
Beta blocker - hypotension, brady, weight.
nitro - headache, dizziness.
anticoagulants - bleeding

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